UNDERGRADUATE STUDIES APPLICATION FORM
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1 Dublin City University UNDERGRADUATE STUDIES APPLICATION FORM Applicants presenting Non-EU School Leaving Qualifications for full-time/part-time undergraduate degree programme. Please return completed form, signed, including all necessary supporting documentation and the appropriate (non-refundable) application fee of 60 to: xxxxxx Please download and save a copy of this form. Alternatively, print and complete this form in BLOCK LETTERS using BLACK ink. All questions must be answered. DO NOT leave blanks. Surname: First Name(s): NAME AS ON BIRTH CERTIFICATE (if different from above): Surname: First Name(s): DATE OF BIRTH: / / GENDER: Male Female CITIZENSHIP: COUNTRY OF BIRTH: COUNTRIES OF RESIDENCE Please indicate the countries in which you were ordinarily resident for the 5 years preceding the date of this application: Country: From: MM/YY To: MM/YY - 1 -
2 R 10 ADDRESS FOR CORRESPONDENCE: (Please notify us if your address changes.) OTHER CONTACT DETAILS: Home Telephone: Mobile Telephone: Work Telephone: Address (Print clearly): TITLE(S) OF THE PROGRAMME(S) FOR WHICH YOU ARE APPLYING FOR ADMISSION IN ORDER OF PREFERENCE (you can apply for up to 3 programmes on this application form): 1 st Preference: Programme Code: DC: 2 nd Preference: Programme Code: DC: 3 rd Preference: Programme Code: DC: SECONDARY SCHOOL EDUCATION Name and Full Postal Address Dates of Attendance (i) from to FINAL SCHOOL LEAVING EXAMINATION RECORD (Please ensure that an official certificate of results is included. A certified translation into English must be provided for results from non-english speaking countries): Second Level School Attended: Date of Attendance: Address of School: Subjects Taken: Results: - 2 -
3 ENGLISH LANGUAGE COMPETENCY (for non-native speakers of the English language only): Non native speakers of English must provide proof of competence in the English language. Please see the DCU web page at for details of the minimum standard required. Copies of completed IELTS, TOEFL examinations etc must be submitted with your application. DETAILS OF FURTHER EDUCATION / PROFESSIONAL EDUCATION (IF ANY) (Transcripts to be included) In chronological order moving from left to right: Institution Attended Period of Attendance Name of Programme Duration of Programme Full-Time or Part-time Title of Award (if any) Name of Awarding Body Have you completed the programme? Yes No Yes No If No please indicate Period Completed to Date: Date on which Final Results will be available: Level/Class of Award Main subject areas studied, with marks or grades obtained; continue on a separate sheet if necessary. DETAILS OF OTHER ACADEMIC, PROFESSIONAL DISTINCTIONS AND CONTINUING EDUCATION: (if there is insufficient space please use a separate sheet and enclose with application) - 3 -
4 EMPLOYMENT SINCE LEAVING FULL-TIME EDUCATION IN CHRONOLOGICAL ORDER BEGINNING WITH THE MOST RECENT: Name and Address of Employer Capacity in which you were employed Dates From To GENERAL INFORMATION Why did you choose the programme that you are applying for, and which type of career or occupation do you hope to pursue as a result of taking this programme? Have you any work experience in this area? If so, give brief details. What attributes or characteristics do you feel you have which make you particularly suitable for this career or occupation? : Other information deemed relevant to the application: - 4
5 It is not a mandatory requirement for an applicant to disclose their disability if they do not wish to do so. However, where a student chooses to disclose their disability, it is advisable to notify the DCU Disability Service on acceptance of a programme place so as to enable the Disability Service to provide reasonable supports to the student during their time at DCU. No applicant will be disadvantaged as a result of disclosing information pertaining to a Medical Condition/Disability. Intending applicants may contact the disability service on tel: +353 (01) or disability.service@dcu.ie for further information. REFEREE CONTACT DETAILS: (The Registry will assume permission to contact referees unless an applicant has stated otherwise.) Name of Referee Position in organisation Address Name of Referee Position in organisation Address Tel.No. Tel.No. DECLARATION: I certify that the information given in this application is correct and I hereby undertake, if admitted as a student member of Dublin City University, to observe and comply with all the regulations of the University. Signature of Applicant: Date: Return the completed application form, ensuring that you have signed the declaration above together with the necessary supporting documentation and the appropriate (non-refundable) application fee 60 for non-eu applicants) by cheque, postal order or bank-draft as follows: REMINDER CHECKLIST: 1. Certified copies of original transcripts of results. Please do not send originals. Copies must be stamped by conferring university. 2. Application fee: 60 for non-eu applicants 3. Photocopy of Birth Certificate Evidence of competency in the English language Certified translation into English of results/qualifications Submission of form: Completed applications and required documents must be sent t o: educoapps@dcu.ie For more information, please visit
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